Plné znění - 241/2006 Sb.

Questionnaire xxx the Xxxxxxxxxx xx Applications xxx xxx Xxxxxxxxx of Xxxxxxxxx Xxxxxxx xx Xxxxxxx xx Criminal Xxxx pursuant to Xxx Xx. 209/1997 Xxxx., xx the xxxxxxxxx of fulancial xxxxxxx to the xxxxxxx of criminal xxxx xxx xx xxxxxxxx certain other xxxx, xx xxxxxxx

Xxxx Xxx/Xxxxx,

Xx xxxxxxxxx xxx xxxxxxxxx xxx with xxxxxxxx questions xx xxxx xxxxxxx situation. Xxxxxxx, filling xx xxxx questionnaire xx xxxxxxxx xxx xxx xxxxx xxxxxxxxxx xx xxxx xxxxxxxxxxx xxx xxx xxxxxxxxx xx xxxxxxxxx support pursuant xx Act xx. 209/1997. Thank xxx xxx xxxx cooperation; xx xx highly xxxxxxxxxxx.

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X. Xxxxxx legibly xxxx xx xxx xxxxxxxx xxxx of xxx xxxxxxxxx - x.x. xxx victim xx the xxxxxxxx xxx xxx xxx xxxxxxxx xxxxxx xxxx, xx xxx xxxxxxxx xx x person xxx xxx xxxx xx xxxxxxxxxxx xx xxx xxxxxxxx act:

1. Xxxxxxx:

2. Given xxxx:

3. Xxxx of xxxxx:

4. Xxxxxxxxx address:

5. Xxxx xxxxxxxx address (xxxxxx xx xxxxxx from xxx xxxxxxxxx address, xxxx):

6. Xxxxx Xxxxxx:

7. X-xxxx xxxxxxx:

8. Nationality:

II. Xx the xxxxxxxxx xx xxxxxxxxxxx by xxxxxxx xxxxxx ("xxxxxxxxxxxxxx") xx xxx xxxxx xx xxxxxxxxx xxxxxxxxxxxxxx (xxx xxxxxxxx, a xxxxx child xxxxxxxxxxx xx xxx/xxx parent) xx xx xxx xxxxx xx x xxxxx xx xxxxxxxx, xxxxxx xxxx xx xxx xxxx xx xxxx xxxxxxxxxxxxxx:

1. Surname:

2. Xxxxx xxxx:

3. Permanent xx registered xxxxxxx:

Xx xxx representative is xxxxxx xxx xxxxxxxxxxx xx xxxxxx of xxx xxxxxxxxx, xxxxxx xxxx xxxxxx a xxxxxxxx xxxxxxxxxxx xxx/xxx xx xxxxxxxxx xxx xxxxxxxxx - a xxxx xx a xxxxx of attorney (xxx contractual representation) xx x xxxx xx the xxxxx xxxxxxxxxxx (xxx statutory xxxxxxxxxxxxxx) xx xxx xxxxx xxxxxxxxxx xxxxxxxx.

XXX. Xx the applicant xx a xxxxxxxx xx x xxxxxx xxx has xxxx xx xxxxxxxxxxx xx xxx respective criminal xxx, xxxxxx fill xx xxx xxxxxxxx xxxx xx xxx xxxxxxxx:

1. Xxxxxxx:

2. Given xxxx:

3. Date xx xxxxx:

4. Xxxx xx xxxxx:

5. Xxxx permanent xxxxxxx:

6. Nationality:

7. Relationship xx the xxxxxxxx xx xxx xxxxxxxxx (x.x. xxxxxx, daughter, xx individual living xx xxxxxx xxxxxxxxx)

Xx xxx xxxxxxxxx xx x survivor xx x xxxxxx xxx xxxx xx xxxxxxxxxxx xx xxx xxxxxxxx xxx, xxxxxx xxxxxx x copy xx xxx death certificate xxx xxx xxxxxxxxx xxxxxxx xxxx the xxxxxxxx supported xx xxx xx obligation xx xxxxxxx xxx xxxxxxxx (in the xxxx xx x xxxxxx-xxxxx xxxxxxxxxxxx, xxxx xxxxxxxxx xxxxxxx xxxxx xxxxxxxxxxxx or x xxxxx decision xx xxx xxxxxxxxxx to xxxxxxx xxx dependent; xx the xxxx xx xxxxxxx xxxxxxx, xxxxxx xxxxxx x xxxxxxxx certificate).

Xxxxxx xxxxxxx xxx xxxx xx xxxxx xxx crime xxx xxxxxxxxx xxx, xx xxx victim xxxxxxx xxxxx xxx xxxxxxxxxxxx xx xxx crime xx x xxxxx xxxx, xxxxxx xxxx xxxxxxx the date xxx the xxxxxx xx xxxxx xxx xxxxxx learned xx xxxx xxxxxxxxxxxx (x.x., xxx date xx xxx xxxxxxx xxxxxx).

XX. Xxxxxx xxxxxxx the xxxxxxxx xxxxxxx xxxxxxxxx (x.x. xxxxxx, public xxxxxxxxxx'x xxxxxx, xxxxx) xxxxx xxxx xxxxxxxx xxxxxxxxx xxxxxxxx xxxxxxxxxxx. Xxxxx xxx xxxxxxxxx xxxxxx xx the xxxx xxxxxxx xx xxx xxxxxxxxxx proceedings.

If xxxxxxxxx, xxxxxx xxxxxx xxx xxxxxx xxxxxxxx xx the abovementioned xxxxxxxx xxxxxxx xxxxxxxxx xxxxx xxxxx xxxxxxxx xxx xxxxx xx xxx xxxxxxxxxx xxxxxxxxxxx (x.x. xxxxxxxxxx xx xxx xxxxxxxxxxxxxxx of xxxxxxxx xxxxxxxxxxx, xxxx xx the xxxxxxxxxx, xxxxxxxxx - xxxxx xx xxxxxxxxx).

Xxxxxxxxx xx the xxxxxxxxxx xx §8 xx Xxx xx. 209/1997, xxx amount xx xxxxxxxxx xxxxxxx xxx xx reduced xx xxxxxxxx xxxxxxxxx on xxxxxxx the xxxxxx xxx xxxx use xx xxx xxxxx xxxxxxxx to xxxxxxx x xxxxx xxx xxxxxxxxxxxx xxxxxxx the xxxxxxxx xx xxx xxxxx person xxxxxxxxxxx xxx xxx xxxx xxxxxxxx. Xx xxx xxxx in xxxx xxxx if xxx xxxxxxxx has xxx xxxx xxxxxxxxxx.

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Xxxx xx xxxx XxXx xx xxx xxxxxxxxx is x survivor xx xx xxxxxxxxxx xxx xxx xxxx xx xxxxxxxxxxx xx xxx xxxxxxxxx crime.

1. Xxx xxx x xxxxx, xxxxxx xx xxxxx of the xxxxxx xxx xxxx xx xxxxxxxxxxx of xxx xxxxxxxx offence?

2. Xxx xxx live xx x common xxxxxxxxx with xxx xxxxxxxx person xxxxx xx the commitment xx the xxxxx?

3. Xxxx you x xxxxxxxxx of xxx xxxxxx or xxx xxx deceased xxxxxxx xx xxxxxxx xxx?

4. Xx any xxxxx xxxxxxx xxxx xxx xxxxxxxxxx described in xxxxxxx 1 to 3? Xxxxxx xxxx xxxxx number, xx xxxxx xx xxx.

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Xxxxxxxxx xx xxx xxxxxxxxxx xx §2, section 2 of Xxx xx. 209/1997, a xxxxxx xxx is x survivor of x xxxxxx who xxxx xx consequence xx a xxxxxxxx xxx xx considered xx xx x xxxxxx xx he xx she xx x xxxxxx, xxxxxx xx xxxxx of xxx xxxxxxxx xxx xxxxx xxxx him xx xxx in xxx xxxx household xx xx xxx xxxxxx was a xxxxxxxxx xx xxx xxxxxxxx xx the xxxxxxxx xxx xxxxxxxx xx xxxxxxx xxx xxxxxx.

Xx xxx applicant xx xxx victim xx a xxxxx xxx xxx xxxxxxxx xxxxxx xxxx, xxxxxx xxxx xx items XX - XIV.

Xxxxxx xxxxxx x point-based xxxxxxxxxx xx xxxx xxx xxxxxxxxx xxxxxxxx xx Xxxxxx Xx. 440/2001 Xxxx. The xxxxxxxxxx xxxxxxxx xxxxxx be xxxxxxxx xxxx the xxxxxxxxx responsible xxx xxx xxxxxx'x xxxxxxxxx. Xxxx xxxxxxx xxxxxx xxxx xxxxxxx x xxxxx-xxxxx xxxxxxxxxx xx xxx pam suffered xxx a point-based xxxxxxxxxx xx xxx xxxxxxxx xx the xxxxxx'x social xxxxxxxx. Xxxxxx xxxx xx xxxx xxxx xxxx xxx point-based assessment xx xxx xxx xxxxxxxx is xxxxxxxx xxx xxx xxxxxxxx xx Act xx. 209/1997. Xxxxxxxxx xx xxx xxxxxxxxxx of §6, section 2 xx Xxx xx. 209/1997, no financial xxxxxxx will xx xxxxxxxx xxxxxx xxx xxxxx xxxxxxxxxx of xxx xxxx suffered xx at least 100 points.

Xxx xxxxxx xxx xxxxxx xxxx xxx financial xxxxxxx xx xxx xxxxxx xx CZK 25,000 xx xx xxxxxx xxxxx xx xxx xxxxxx costs xx medical xxxxxxxxx xxx xxxx income (§7, xxxxxxx 1, xxxxxx x xx Xxx No. 209/1997 Xxxx.). lf xxx xxxxxx xx apply xxx x xxxx xxx payment, xxxxx xx no xxxx xx xxxx xx xxxxx XXX - XxX.

Xxxx xxxxxxxx xxx xxxxxxxx for xxxxxxxxxx, xxxxxxxx xxxxxxxxx, xxxxxxxxxxxxxx costs, xxxxxx xx xxxxxxxxx xx xxxx xxx xx xxx xxxx xx xxxx medical xxxxxxxxx, xxxxxxxxx xxxxxxxxxxxxxx xxxxx xxx., xxxxxxxx xxxx xxxxx xxxx xxx xxxx xxxx by xx xxxxxxxxx xxxxxxx. xx xxxx expenses xxx xxx xxxxxx xx xxxxxxxxxxx xxxxxxxx, xxx Xxxxxxxx xx Xxxxxxx may xxx xxxx them into xxxxxxxxxxxxx.

Xxxxxx attach xxx documents xxxxxxxxxx xxxx xxxxx xx xxx xxxxxxxxxxx.

Xx the xxxxxxxxx xx xx xxxxxxxx, these xxxxxxxxx xxxxx include a xxxxxxxxx xxxx xxx/xxx xxxxxxxx xxxxxxxxxx the xxxxxxx salary according xx §351 xx. xxx. xx Act xx. 262/2006, xxx Xxxxx Xxxxxx Xxxx, xx amended. xx xxx applicant xx xxxx-xxxxxxxx, such xxxxxxxx xxxxx xx x xxxx xx xxx/xxx xxxx xxxxxx tax xxxxxx. lf the xxxxxxxxx xx x xxxxxxx xxxxxx xxx xx able xx xxxxx xxx/xxx xxxxxxxx xxxxxx standing, xxxxxx xxxxxx x document xxxxxxxxxx xxx amount xx xxx xxxxxxxxxx xxxxxxx. lf xxx xxx xxxxxx xxx xxxxxxxxx'x xxxxxx xxxxxxxxx xxxxxx xx proven, xx xxxxxxxxxxx cases xx affidavit may xx xxxxxxxx.

My xxxxxx xxxxxxxx xxx xxxx xxxxxxxx xx x xxxxxx of xxx criminal xxx xx which X xxx x victim. X xxxx xxx xxx xxxx xxxxxxxxxxx xxx the xxxx 1 xxxx xxxxxxxx xx x result xx xxx xxxxxxxx xxx.

X hereby xxxxxx xxxx X xxxx xxx xxxxxx xxx xxxxx xxx xxxxxxxxx xxxxxxx xx any xxxxxxx xxxxx xxx xxxxxxxxxxxx for xxx xxxx xxxxxxxx as x xxxxxx of xxx xxxxxxxx xxx xx any xxxxxxx xxxxx xxxx xxx Xxxxx Xxxxxxxx.

X xxxxxxxxxxx xxxx xxxxxxxxx to §12 xx Act Xx. 209/1997 Xxxx., xx xxx xxxxxxxxx xx xxxxxxxxx xxxxxxx xxx xxx victims xx criminal acts xxx xx xxxxxxxx xxxxxxx xxxxx acts, xx xxxxxxx, I xx xxxxxxx xx xxxxxxxxx the Ministry xx Justice xxx xxxxxx xxxxxxxx as xxxxxxxxxxxx xxx the xxxx xxxxxxxx, xx xx the xxxxxx xx xxx financial xxxxxxx, xxxxxx xxxx xxxxx xxxx xxx xxxx xx xxxxxxxxx xxx xxxxxxx xxxxxxx. X xxxx acknowledge xxxx, xxxxx the xxxxx xx xxx xxxx-xxxx xxxxxx, X xxx xxxx an xxxxxxxxxxx asking the Xxxxxxxx xx Xxxxxxx xx xxxxx the xxxxx'x xxxxx xxx xxx xxxxxx of xxx xxxxxxxx xxxxxxx, xxxxxx xxxx x xxxxxx xx xxxx xxxxxxxx xx xx xxxxxx standing, the xxxxx extent of xxxx suffered xxx xxx xxxxxx xx xxxxxxxxxxxx xxxxxxxx.

X xxxx xxxxxxxxxxx xxxx xxxxxxxxxxx xxxxxx xxxxx xx xxxxxxxxxx xxxxxxxxxxx or xxxxxxxxxxx xxxxxxxxxxx xxx xxx xxxxxxxx of xxxxxxxxxxxxx gaining xxxxxxxx xxx xxxxxxxxx xx xxxxxxx pursuant xx §21, xxxxxxx 1, xxxxxx x) xx Xxx xx. 200/1990 Xxxx., xx offences xx amended.

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Signature xx xxx applicant or xxx/xxx representative

- Xxxx xxxxxxx xx xxx xxxxxxxxxxx xxx xxx xxxxxxxxx xx xxxxxxxxx xxxxxxx xxxxxxxx to Xxx No. 209/1997, xxx Xxxxxxxx xx Xxxxxxx shall xxxxxxx xxxxxxx xxx xxxxxx xx x serial xxxxxx. Xxxxxxxxxxxx, the Xxxxxxxx xxxxx initiate xx xxxxxxxxxxxxx xxxx xxx xxxxxx xx x similar xxxxxxxxx xx xxx xxx xxxxxxxx xxxxxxx of xxx case. Xxxxxx xxxxx xxxxxx xxxx xxx date xx xxx xxxxxxx xx xxx application xxx xxxxxxxxxx xx xxx xxxxxxxxx xxxxxxxxx, xxx Xxxxxxxx shall either xxxxxxx xxx xxxxxxx xx xxxxxx the xxxxxxxxx xx the xxxxxxx why such xxxxxxx has xxxx xxxxxxxx.

- Xxx applicant xxxxx be xxxxxxxxxx x xxxxxx xx xxx Act Xx. 209/1997 Xxxx. xxxx xx xx/xxx has xxxxxxxx xxxxxx xxxx xx x xxxxxx xx xxx xxxxxxxxxx xx x xxxxx. X xxxxxxxxx xxx xxx xxx xxxx xxxxxxxxx xxx the xxxxxx'x xxxxxxx xx xxxxxxxx xxxxxxx shall xx xxx xxxxxx xx the xxxxx-xxxxx xxxxxxxxxx xx the xxx xxxxxxxx (xxx xxx weakening xx xxxxxx xxxxxxxx), xxxxx xxxx be at xxxxx 100 points. Xxxxxxxxx xx x xxxxxx who xxx xxxx xx consequence xx x xxxxx xxxxx be xxxxxxxxxx xx xx a xxxxxx xx the xxxxxxxx xx x xxxxxx, xxxxxx xx xxxxx of the xxxxxxxx and xxx xxxxxxxx xxxxxx x xxxxxxxxx xxxx xxx xxxxxxxx xx the xxxx xx xxx/xxx xxxxx or if xxx xxxxxxxx xxxxxxxxx xx xxx required xx xxxxxxx xxx xxxxxxxx.

- Xxx Xx. 209/1997 Xxxx. on xxx xxxxxxxxx xx xxxxxxxxx support xx xxxxxxx xx criminal xxxx stipulates x xxxxxxxxxx term xx 1 xxxx xxxx xxx date on xxxxx xxx xxxxxx xxxxxxx of xxx xxxx xxxxxx by xxx crime. If xxxx xxxx does xxx xxxxxxxx xxxx xxx xxxx xx xxx xxxxxxxxxx of xxx xxxxx, xxx xxxxxx shall provide xxxxxxxx xx xxx xxxx xx xxxxx xx/xxx xxxxxxx xx xxx xxxxxxxxxxxx. Xxx Xxxxxxxx xx Xxxxxxx xxxxxx xxxx an xxxxxxxxxxx xxx the xxxxxxxxx xx xxxxxxxxx xxxxxxx xxxxxxxx anytime xxxxx xxx xxxxx xx xxx xxxxxxxxxxxxxx xxxxxx.

- Xxxxxxxxx xxxxxxx xx xxxxxxx xxx xx x xxxxxx xxx has xxxxxxxx xxxxxx xxxx xx x xxxxxx of xxx xxxxxxxxxx xx x crime xxx xx in the xxxx of x xxxx xxx xxxxxxxxx xx CZK 25,000 xx an amount xxxxx to lost xxxxxx or xxx xxxxx xx xxxxxxx xxxxxxxxx xx xxxxxx xx xxx xxxxxx, xxxxxxx xx xxx xxxxxx previously xxxx xx xxx xxxxxx xx xxxxxxxxxxxx for xxx harm incurred. Xxx xxxxx amount xx xxxx xxxxxxx xxxx not exceed XXX 150,000. If, xxxxx xxx xxxxxxxxx xx xxxxxxx, xxx xxxxxx proves xxxx xxx xxxx suffered xxxxxxx xxx xxxxxx xxxxxxxx, the xxxxxx xxx xxxxxxx xxxxxxxxxx xxxxxxx xx xx xxx xxxxxx xx XXX 150,000 if xx/xxx xxxxxxx xxx xx xxxxxx the xxxxxxxxxxxxxx xxxxxx of xxxx (i.e., 1 xxxx xxxx xxx xxxx xx xxxxx xxx xxxxxx learned xx xxx xxxx xxxxxx xx the xxxxx); xx xxxx xxxx, any xxxxxxx xxxxxxx paid will xx taken xxxx xxxxxxx.

- Xx xxxxxxxxxx xxx xx a xxxxxxxx of a xxxxxx who xxx xxxx as a xxxxxx xx xxx xxxxxxxxxx xx x xxxxx (x xxxxxx, xxxxxx xx xxxxx xx the xxxxxxxx xxxxxx xx a xxxxxx xxxxxxxxx with xxx xxxxxxxx xx xxx xxxx xx xxx/xxx xxxxx xx xxxxxxxxx xx xx xxxxxxxx xx xx xxxxxxxxx xx the xxxxxxxx) xxxxx be xxxxxxxx with x xxxx xxx xxxxxxxxx xx XXX 150,000. Xxx xxxxx amount xxxxxxxx xx xxxxxxxxx xxxxxxx xxxxx xxx xxxxxx XXX 450,000; xxxxxx the xxxxxx xx victims xxxxxx xxxxx, xxx xxxxxx xxxxxxxx xxx xxxxxx xxxxx xx xxxxxxx xxxxxxxxxxx.

- Xxx No. 209/1997 Coll. xxxx xxx xxxxxxx xxx xxxxxxxxx of the xxxxxxxxx xxxxxxxxx xx xxxxxxxxx of xxxxx xxxxxxxx xxxxxxx xx xxxxxxxxxx xxxxxxxxx insurance. Xx xxxxxxx related xx xxxxxxx xxxxxxxxx, xxxxxxxxxxxx xxx xxxxxxxxx xxxxxxxx should xxxx xx xxxxxxxx xx xxx insurers xxxxxxxxx xxxx xxxxxxxxx insurance. Xxxx xx xxxxxxxx xxxxx, xx xxxx xx xxxxxxxxxxx xxxxxxxxxxxxx, xxx xx application xxx the provision xx xxxxxxxxx xxxxxxx xx filed with xxx Xxxxxxxx of Xxxxxxx.

- Xxxxxx xxxx xx xxxx xxxx xxx available documents xxx xxxxxxxxxxxxx required xxx the respective xxxxx must xx xxxxxxxx xx xxx xxxxxxxxxxx. Xx xxx xxxxxxxxx xxxxx xx xx xx, xxx Xxxxxxxx xx Justice xxxxxx xxxxxxxx xxxxxxx xxx xxxxxxxxxxx. Should xxx applicant xxxx xx xxxxxxx xxx xxxx xxxxxxxxx xxx xxxxxxxxxxxxx xxxx xxxxxx x supplementary deadline, xxxx xxxx may xxxxxxx x decision xx withhold xxx xxxxxxx as xxx Xxx Xx. 209/1997 Xxxx. Xxxx xxxxx xxx, however, xxxxxxxxx xxx xxxxxx xx xxxxxxx application.

- Please xxxx xx xxxx xxxx the xxxxxxxxx xxxxx be xxxxxxx xx xxxxxx xxx xxxxxxxxx amount received xx xxxxxxxxxxxx xxx xxxx (xxxx xxx xxxxxxxx, xxxxxxxx xxx.) xx the account xx xxx Xxxxxxxx xx Xxxxxxx xx xx xxx xxxxxx xx the xxxxxxx xxxxxxxx. Xxxx xxxxxxxxxx xxxx not xxxxx xx xx/xxx xxx xxx xxxxxxxx xxx xxxxxxxxxxxx. Xx xx xxxxxxxxx xx xxx xxxxxx xx an xxxxxxxxxxx, xxx Xxxxxxxx xx Xxxxxxx xxx xxxxx xxx xxxxx'x xxxxx to xxxxx xxx xxxxxx of xxx xxxxxxxxx xxxxxxx xxxxxxxx after xxx xxxxx of the xxxx-xxxx term, xxxxxxxx xxxx x xxxxxx xx xxxxxxxxx xx xxx xxxxxx'x social xxxxxxxx, xxx xxxxx xxxxxx of xxx xxxx suffered xxx xxx amount of xxxxxxxxxxxx paid to xxx xxxxxx.

Vážený xxx/xxxx/xxxxxx

Xxxxxxxxxxxxxxx xx, xx x xxxxxxxx, x xxxxxx xx xxxxxxxxxx, sme xxxxxx Vás obťažovať xxxxxxxxxxxx xxxxxxxx. X xxxxxx rýchleho posúdenia Xxxxx žiadosti x xxxxxxxxxxx peňažnej xxxxxx xxxxxxx trestnej činnosti xxxľx xxxxxx č. 209/1997 Zb., xx však xxxxxxxxx xxxxx xxxxxxxxx xxxxxxxxxx. Xxxxxxxx Xxx xx xxxxxxxxxx, ktorú xx xxxxx ceníme.

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I. Xxxxxx, xxxxxxx čitateľne osobné xxxxx x xxxxxxxľxxx - obeti xxxxxxxxx xxxx, ktorej xxôxxxxxx xxxx xx xxxxxx, xxxxx xxxxx xxxxxxxxxx xx osobe, ktorá x xôxxxxxx trestného xxxx xxxxxxx:

1. Priezvisko:

2. Xxxx:

3. Dátum xxxxxxxxx:

4. Xxxxxx xxxxxxxx xxxxxx:

5. Xxxxxxxxxxxxxx xxxxxx (x xxxxxxx, xx xx xxxx xx xxxxxx xxxxxxxx xxxxxxxx):

6. Xxxxxxx:

7. X-Xxxx:

8. Xxxxxxxxxx:

XX. Ak xxxxxxxľx zastupuje iná xxxxx (xxxxxxxx) na xxxxxxx zákonného xxxxxxxxxx (xxxx. xxxxxxxx xxxxx xxxxxx xxxxxxx) alebo xx xxxxxxx xxxxxx x xxxxx moci, xxxxxxx xxxxx x xxxxxxxxxx:

1. Priezvisko:

2. Xxxx:

3. Xxxxxxxxxxxxxx xxxxxx:

Xx xxxxxxx xx xxx xxxxx, xxxx sa xxxxxxx xxxxxxxxxx, xxxxx xxxxxxxxxx xxxxxxx. Xxxxx x xxxxxxxx priložte kópiu xxxxx xxxx (xxx xxxxxxxx xxxxxxxxx) xxxxx xxxxx xxxxxxx listu (x xxxxxxx zákonného xxxxxxxxxx) xxxxx xxx xxxxxxx xxxxxxx.

XXX. Xx xxxxxxxľ xxxxx osoba xxxxxxxxx po xxxxx, xxxxx v xôxxxxxx xxxxxxxxx xxxx xxxxxxx, xxxxxxx, xxxxxx, xx xxxxx x umretej xxxxx:

1. Xxxxxxxxxx:

2. Meno:

3. Xxxxx narodenia:

4. Xxxxx xxxxxx:

5. Xxxxxxxx xxxxxxxx:

7. Xxxxxxxxxx:

8. V akom xxxxxx xxxx zomretá xxxxx v xôxxxxxx xxxxxxxxx činu x xxxxx žiadateľa (xxxx, xxxxx, osoba žijúca x spoločnej domácnosti):

Ak xx xxxxxxxľ xxxxxx xxxxxxxxxx po xxxxx, xxxxx v dôsledku xxxxxxxxx xxxx xxxxxxx, x xxxxxxxx sa xxxx xxxxxxxx kópia xxxxxxxx listu x xxxxxxx, xxxxx xxxxxxxxx xxxxxxxxxx, xx xxxxxx xxxxx vyživovala pozostalú xxxxx alebo xxxx xxxxxxxxx ju vyživovať (xx xxxxxx rodič - xxxxx pôjde x xxxxx xxxx xxxxx xxxxxxxxxxx xxxx x xxxxxxxxxxx xxxxxxxxxx, xxx xxxxxxxx takou xxxxxxxx xxxx xxxxxxx xxxx a xxx.)

XX. Xxxxxx, či xxxxxxx xxxxxxxx xxxxxxx xxxxx xxxxxxxxxxxxxxx xxxxx xxxxx xxxxxxxx xx peňažný xxxx; x xxxxx xxxxxxx láskavo xxxxxxx xxxxx Xxxxx účtu.

V. Xxxxxx dátum, kedy xx xxxx xxxxxxxxx x xxxxx xxôxxxxxxx xxxxxxxx xxxxx.

Xxxxxx xxxxx xxxxxxxxx xxxxxxxxx činu x xx sa xxxx x xxxxx xxx xxôxxxxxxx xxxxxxxxx xx xxxxôx, xxxxxx xxxx x xxx (xxxxxxxxx x lekárskej xxxxxx - dátum xxx vystavenia).

VI. Xxxxxxx xxxxx xxxxx x xxxxxxxx konaní (xxxxxxxxx xxxxx, xxxxxx xxxxxxxxxxxxxx, xxx), ktorý xxxxxxxxx xxxxx xxxxxxx o xxxxxxxx xxxx. Xxxxxx xx xxxxxxx xxxxxx, xxx ktorou xxxxxxxx xxxxxxxxxxxx.

Xx xxxx x xxxxxxxxxx xxxxxxxx xxxxxxxxxxx xxxxxx činného x xxxxxxxx xxxxxx, xxxxx xxxx xxxxxxxxx x xxx, x xxxx xxxxxx sa xxx xxxxxxxx (xxxx. uznesenie x xxxxxxxx xxxxxxxxx xxxxxxxx, xxxx obžaloby, xxxxxxxx - x xxxxxxxxxxxxx), pripojte ho x žiadosti.

VII. Uveďte, xxxx xxôxxxxx xxx xxxxxxxxx xxxxx xx xxxxxxx xxxxx od xxxxxxxľx xxxxx xxxx xxxxx, xxxxx xxxxxxxxx xx xxxxx.

Xxxľx xxxxxxxxxxx §8 zákona č. 209/1997 (Xx)., xxxxxxxx xxxxx sa xôxx xxxxxx xxxxx sa xxxxxxxx x xxxxxxxxxxxxx xx to, xx xxxx xxxxxxx všetky xxxxxxx xxxxxxxxxxx xx xxxxxxxxxx xxxxxx xx xxxxxxx škody xx xxxxxxxľx xxxxx xxxx xxxxx, xxxxx xxxxxxxxx xx xxxxx. Xxxxx xxx nevyplňujte, xx xxxxxxxľx xxxxxxxxx činu xxxxxxxxx.

Xxx VIII. Xxxxxxx, xx xxxxxxxľ je xxxxxxxxxx po xxxxx, xxxxx x xôxxxxxx xxxxxxxxx xxxx zomrela.

VIII. Xxxxxx, xx xxx xxxxxxx osobou, xxxxx xxľxx podmienky xxxxxxx x §2 xxxx. 2 xxxxxx x. 209/1997 Zb., xxxxxxxx xxľxx xxôx xxľxx xxxxx xxxxxxxxx, xx xx Xxx xxxxx xxxxxxxxxxx xxxxx.

1. Xxxx xxx xxxxxxx, xxxxxxxx xxxxx xxxxxxxx xxxxx, xxxxx zomrela x xôxxxxxx xxxxxxxxx činu?

2. Xxxx xxx x xxxxxx trestného xxxx xxxx xxxxxxxxx xxxxxxxxx xxxx x spoločnej xxxxxxxxxx?

3. Poskytovala Xxx xxxx xxxxxxxxx činu xxxxxx, či xxxx x xxxx xxxxxxx?

4. Xxľxxxx xxxxx xxxxx xxxxxxxxxxx xxxxxxxxx 1 xx 3? Xxxxxx xxx xxxxx, ak Xxx je xxxxx.

Xxxľx xxxxxxxxxxx §2 odst. 2 zákona č. 209/1997 Xx. xx xx obeť považuje xxxxx xxxxxxxxx xx xxxxx, ktorá v xôxxxxxx xxxxxxxxx činu xxxxxxx, xx je xxxxxxx, manželom xxxxx xxxxxxxx xxxxxxxxx x xxxxxxx v xxxx xxxx smrti x xxx žila x xxxxxxxxxx alebo xxxxx, xxxxxx xxxxxx poskytoval xxxxx bol xxxxxxx xxxxxxxxxx výživu.

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Body IX. xx XXX. Xxxxxxx, xx xx žiadateľ xxxx xxxxxx xxxxxxxxx xxxx x xxxx xx xxôxxxxxx ujma xx xxxxxx.

XX. Uveďte xxxxx, xxxx xx xxxxxxxx liečenie, respektíve xxxx xx skončila xxxxxxxx xxxxxxxxxxx.

X. Celková xxxxx xxxxxxxx xxxxxxxxxxx xx bolesť činí:

K xxxxxxxx sa xxxx xxxxxxxx xxxxxx xxxxxxxxxxx xx xxxxxx xxxľx xxxxxxxx č. 440/2001 Zb., ktoré xxxxxxxľ získa xx xxxxxx, ktorý ho xxxxxxxxx. Tento xxxxxxxx xxxxxxx xxxx xxxxxxxxx xxxxxx hodnotenie xxxxxxxxx xxxxxxx x bodové xxxxxxxxxx xxxxxxxx spoločenského xxxxxxxxxx. Xxxxxxxxxxx, xx xxx xxxxx xxxxxx č. 209/1997 Zb. xx xxxxxxxxxx xxx xxxxxx xxxxxxxxxxx xxxxxxxxx xxxxxxx. Podľa xxxxxxxxxxx §6 odst. 2 xxxxxx x. 209/1997 Xx. xxxxxxx xxxxxxxxx' xxxxxxx xxxxx, xx xxxxxx xxxxxxxxxxx xxxxxxxxx bolesti xxxxxxxxxx xxxxxxxx 100 xxxxx.

XX. Xxxxxx, xx xxxxxxx x xxxxxxxxxxx peňažnej xxxxxx vo výške xxxxxxxxx xxxxxxx 25&xxxx;000.- Xx xxxxx či xxxxxxxx xxxxx ušlého xxxxxxx x xxxxxxxx xx xxxxxxxx.

Xxxľx xxxxxxxxxxx §7 xxxx. 1 xxxx. x) xxxxxx x. 209/1997 Xx. xx žiadosť obete xxxxx poskytnúť peňažnú xxxxx vo xxxxx xxxxxxxxx xxxx 25&xxxx;000.- Xx, alebo vo xxxxx xxxxxxxxxxxxxx xxxxxxxxxxx xxxxxxxx xx liečenie x ušlému xxxxxxx. Xx xx xxxxxxxxxx xxxxxx x peňažnú xxxxx vo xxxxx xxxxxxxxx xxxxxxx, xxxxxxxx xx xxxxxxxxx xxxx XXX. - XXX. xxxxx xxxxxxxxx.

XXX. Xxxxxxx xxxxxxx x liečením xxxxxx:

Xxx x xxxxxxx xx lieky, xxxxxxxxxxxx xxxôxxx, xxxxxxx xx xxxxxxxxxxxxx, pribranie xxxxxx xxxxx xx pomoc x xxxxxxxxxx xx xxxxxxxxxx, zvýšené xxxxxxx xx dopravu, x xxx. xxx podmienkou, xx xxxxx xxxxxxx xxxxxxxxx xxxxxxxxx. Xx xxxxxxx náklady xx xxxxx xxxxxxx, xxxx xx ne ministerstvo xxxxxxxxxxxxxx xxxxxx xxxx xxxx zreteľ.

XIII. Xxxxxxx xxxxxxxxx xxxxxx xxxxxxxľx xxxx a xx xxxxxx xxxx xx xxxxxx spôsobenej trestným xxxxx.

X xxxxxxxx xxxxxxxx xxxxxxx, xxxxx potvrdzujú xxxxxxx skutočnosti.

V xxxxxxx, xx xxxxxxxľ xx x xxxxxxxxxxxxxx pomere, xôxxx o xxxxxxxxxx xxxxxxxxxxxxľx o xxxxxxxxxx xxxxxxx xxxľx §351 x nasl. xxxxxx x. 262/2006 Xx., xxxxxxxx xxxxx, v xxxxx xxxxxxxxxx xxxxxxxxx. Xx xx xxxxxxxľ xxxxxx xxxxxxxxxx zárobkovo xxxxxx, xxxxx xxxxxxxx xxxx xxxxxxxxx xxxx xxxxxxxxxx daňového priznania. Xx xxxxxxxľ xxxxxx xxxxxxxx xôxxxxxx, xxxxxxxx, xxxxx xôxx xxxxxxx xxxxxxxx xxxxxxxx xxxxxxxx, xxxx xxxxxxxxxx o xxxxx xxxxxxxxxx dôchodku. X xxxxxxx, xx x nejakého xxxxxxxxx xôxxxx xxxxxxx xxxxxxx xxxxxxxxx pomery žiadateľa, x krajnom xxxxxxx xx xxxxx xxxxxxxx xxxxxxxxxx x xxxx xxxxxxx xxxxxxxxxx.

XXX. Xxxxxx xxxxx xxxxxxxxxxxx xxxxx (xxxxxxxxxxx xôxxxxxx) a xxxx, xxxxxx xxx xxxxxxxľ xxxxxx, xx xxxxxxx po xxxxxx xxxx xx xxxxxx, xxôxxxxxxx xxxxxxxx xxxxx.

X xxxxxxxx priložte xxxxxxxxxx xxxxxxxxxxxxľx xxxxx xxxxxxxxx x xxxxx xxxxxxxxxxxx xxxxx. X prípade, xx x xôxxxxxx xxxxx xx zdraví xxôxxxxxxx xxxxxxxx xxxxx Xxx xxxxxxxx xxxxxxxxx xôxxxxxx, uveďte x xxxxxxx xxxx výšku.

Xxxx majetkové xxxxxx xx také, xx xxxxxxxx činom, xxxxxxx xxx xxx(x) obeťou, xx xxxx sociálna xxxxxxxx xxxxxxxx. Xxxxx, xxxxx mi xxxxx xxôxxxxx, dosiaľ xxxxxx xxxxxxxx.

Xxxxxx xxxxxxxxxx, že xxxxx xx xxxxxxx xxxxx či xxxxxxx xxxxx xx xxxxxxxxxxx xxxx xxôxxxxxxx trestným xxxxx xxx xxxxxxxxxx(x) x xxxxxxx xxxx xxxxx xxx x Xxxxxx (Slovenskej) xxxxxxxxx.

Xxxxxx xx xxxxxxx, že xx xxxľx xxx. §12 zákona x. 209/1997 Xx., o xxxxxxxxxx xxxxxxxx xxxxxx xxxxxxx xxxxxxxx xxxxxxxx x x zmene x x xxxxxxxx xxxxxxxxxx zákonov, x xxxxx xxxxxxxxxx xxxxxxxxx, xxxxxx xxxxxxxxx xx xxxxxxx xxxxx odo xxx, xxx mi xxxxxxxx pomoc, xxxxxxx xx účet Ministerstva xxxxxxxxxxxxxx čiastky, xxxxx xxx dostal(a) ako xxxxxxx xxxxx, x xx až xx xxxxx xxxxxxxxxxx xxxxxx. Xxxxxxx x tým xxxxxx xx xxxxxxx, xx xx xxxxxxxx xxxxxxxxxx xäxxxxxxx doby xôxxx požiadať Ministerstvo xxxxxxxxxxxxxx, aby xx x xxxx xxxxx xxxxxx xxxxx xx xxxxxxxx xxxxxxxxxxx pomoci, xx xxxx xxxxxxxx xxxxxxxx xxxx taký xxxxxx xxôxxxxxxxx, celková xxxxx xxxxx, ktorú xx xxôxxxxxx a xxxxx náhrady, ktorú xxx xxxxxx(x).

Xxxxxx xxxx xx xxxxxxx, že xxxxxxxxx xxxxxxxx xxxxxxxxxxx xxxxx neúplného xxxxx xx jeho xxxxxxxxx xx účelom xxxxxxxx xxxxxxxxxxxx xxxxxx, sa xôxxx dopustiť xxxxxxxxxx xxxľx §21 xxxx. 1 xxxx. x) xxxxxx č. 200/1990 Xx., x xxxxxxxxxxxx, x znení neskorších xxxxxxxxx.

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xxxxxx žiadateľa xxxxx xxxxxxxx

- Ministerstvo xxxxxxxxxxxxxx Xxxxx republiky xx xxxxxxx xxxxxxxx x xxxxxxxxxxx xxxxxxxx xxxxxx xxxľx xxxxxx č. 209/1997 Zb. xxxxxxx xxx xxxxxx x xxxxx xxxxxxxx xxxxx. Xxxxx xxxx xxxxxxxxxx xx xxxxxxx xx xx xxxx xxxxxxxx orgáne podľa xxxxxxxxxxx xxxxxxxxx xxxxxxx. Xx troch xxxxxxxx xx xxxxxx xxxxxxxx x predložení potrebných xxxxxxxx xxx pomoc xxxxxxxx xxxxx xxxxxxxľxxx xxxxxx dôvody, xxxxx xxxxx xxxxxxx poskynúť.

- X xxxxxx xxxxxx č. 209/1997 Zb. xxxx žiadateľ xxxxxxxxxx xx xxxx xxx v xxxxxxx, xx mu v xôxxxxxx xxxxxxxxx činu xxxx spôsobené xxxxxxxxxx xxxxxxx. Xxxxxxxxxxx, nie xxxx postačujúcou xxxxxxxxxx xx xxxxxxxxx xxxxxxxx xxxxxx xxxxx xxxxx xx výška xxxxxxxx xxxxxxxxxxx bolesti (nie xxxx xxxxxxxx spoločenského xxxxxxxxxx) dosahujúceho xxxxx 100 xxxxx. Za xxxx sa xxxxxxxx xx osoba xxxxxxxxx xx xxxxx, xxxxx x xôxxxxxx xxxxxxxxx xxxx xxxxxxx, xx xxxx xxxxxxx, xxxxxxxx xxxxx dieťaťom zomretého x xxxxxxx x xxxx xxxx xxxxx x xxx xxxx x domácnosti, xxxxx xxxxx, xxxxxx xxxxxxx xxxxxxxxxx alebo xxx xxxxxxx poskytovať xxxxxx.

- Xxxxx č. 209/1997 Zb. x xxxxxxxxxx peňažitej xxxxxx xxxxxxx xxxxxxxx xxxxxxxx xxxxxxxxx xxxxxxxxxxx (prepadnú) xxxx 1 xxxx xxx xxx, xxx xx obeť xxxxxxxxx x xxxxx xxôxxxxxxx xxxxxxxx xxxxx. Xx xxxxx xxxx xx xxx xx deň xxxxxxxxx trestného xxxx, xxxx xxxxxxxx xxxxxxx, xxxx xx xx xxxxx. Ministerstvo xxxxxxxxxxxxxx xxxôxx xxxxxxxx xxxxxxxxxx x xxxxxxxxxxx xxxxxxxx xxxxxx, ktoré xx xxxxxxxx xx xxxxxxxx xxxxxxxxxx lehoty.

- Xxxxx xx xx xxxxxxx xxxxx, ktorej x xôxxxxxx xxxxxxxxx xxxx xxxxxxx xxxxx na xxxxxx, xxxxxxxx v xxxxxxxxx xxxx 25&xxxx;000.- Xx xxxxx xx xxxxx, xxxxx xxxxxxxxxxx xxxxxxxxxx xxxxxx na xxxxxxx, preukázané náklady xxxxxxx s liečením, xxxxxxx x súčet xxxxxxxx čiastok, xxxxx xxxx x titulu xxxxxxx xxxxx xx xxxxxxx; xxxxx vo xxxxxx xxxxx xxxxxx xxxxxxxxxx xxxx 150&xxxx;000.- Xx. Xx xxxx - po xxx, xxx xxx xxxxxxxx xxxxx - preukáže, xx jej vzniknutá xxxxx xx vyššia xxx xx, xxxxx xxxx xxxxxxxxx xx xxxxxxxxxxx xxxxxx, xx xxx xxxxxxx x xxxxxx stanovenej xxxxx xxxxxxx xxx xxxxx xxxxxxxxx xxxxx opäť, x xx xx xx maximálnej xxxxx 150&xxxx;000.- Kč; xxxxxx xx prihliadne xx xxxxxxx, xxxxx xx xxxx xxxxxxxxx.

- Xxxxxxxx xxxxx, ktorá xx xxxxxxxxxx xx xxxxx, xxxxx v dôsledku xxxxxxxxx činu zomrela (xx xxxx xxxxxxx, xxxxxxxx alebo xxxxxxxx xxxxxxxxx a xxxxxxx x čase xxxx xxxxx s xxx xxxx v domácnosti, xxxxx xxx zomretý xxxxxxxxxx, xx bol xxxxxxx poskytovať xxxxxx), xx xxxxxxxx xxxxxxx xxxxx v paušálnej xxxx 150 000.- Xx; xxxxx vo xxxxxx xxxxx xxxxxx xxxxxxxxxx xxxx 450&xxxx;000.- Xx, x xx je xxxxx xxxxx xxxx xxx xxx xxxxx, xxxxxxxxxxx xxxxxxx xx xxx xxxxxx obeti xxxxxxxxx xxxxx.

- Zákon č. 209/1997 Zb. xxxxxxxxxxxx xxxxxxxx xxxxxxxxxxx xxxxxxxxxxxxx xxxxxxxxxxľx xxxxxxxxxx xxxxxxxx, na xxxxx xxxxäxxxx xxxxxxx xxxxxxx xxxxxxxxx xxxxxxxxxxxxx. Xxxxx xx xxxxxxxx x záležitostiach xxxxxxxxxx xxxôx xxxxxx xxxxxxx, xxxxx spravuje xxxxxxxxx xxxxxxxxxxxxx, x xxxxxxxxxxx xxxxxxxxx xxxxxxx. Xxx x xxxxxx ojedinelých xxxxxxxxx x xxxxxxxxxxxxx xx konkrétne výnimočné xxxxxxxxx xx xxxxx xxxxxx xxxxxxxxxxxx spravodlivosti x xxxxxxxxxxx peňažnej xxxxxx.

- Xxxxxxxxxxx, že xx xxxxxxxxxx xxxxxxxx xxxxxx dostupné doklady x potvrdenia, xx xxxxx xxxxxxxxxx xxx xxxxxxxxxxxx položkách. Ak xxx žiadateľ neučiní, xxxxxxxxxxxx xxxxxxxxxxxxxx xxxôxx xxxxxxx xxxxxxx. Ak xxxxxx xxxxxxxxxx a xxxxxxx xxx dodatočne xxxxxx, xxxx xxxxxxxxxx xôxx xxx xôxxxxx xxxxxxxxxxxxx peňažnej xxxxxx xxxľx xxxxxx č. 209/1997 Zb. Xx xxxx nevylučuje xxxxxxx xxxxx novú xxxxxxx.

- Xxxxxxxxxxxx, xx xx xxxx xxxxxxxľxxx xxxxxxxxxx xxxxxxx pomoc, xxxxxxxľ je do xxxxxxx xxxxx odo xxx xxxxxxxxxxx xxxxxx xxxxxxx xx účet xxxxxxxxxxxx xxxxxxxxxxxxxx xxxx, xxxxx dostal ako xxxxxxx xxxxx (xx xxxxxxxľx, xxxxxxxxx x xxx.) xx do xxxxx xxxxxxxxxxx pomoci. Xxxx xxxxxxxxx nemá, xx xx xxxxx xxxxxxxxxx. Xx základe xxxxxxxx xxxxx sa xxxxxxxxxxxx xxxxxxxxxxxxxx xôxx x mene xxxxx xx xxxxxxxx xxxxxxxxxx xäxxxxxxx xxxx vzdať xxxxx na vrátenie xxxxxxxxxxx peňažnej xxxxxx. Xx xxxxxx postup xxôxxxxxxx xxxxxxxx xxxxxxxx xxxxx, celková výška xxxxx, xxxxx xxx xxôxxxxxx, x xxxxx xxxxxxx, xxxxx xxxx xxxxxxx.